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BMJ Open Qual. 2017 Sep 17;6(2):e000143. doi: 10.1136/bmjoq-2017-000143. eCollection 2017.

The game of telephone: a sustained, low-cost, quality improvement initiative to enhance communication between patients and their resident physician.

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Department of General Medicine, The University of Kansas Health System, Kansas City, Kansas, USA.
Internal Medicine, The University of Kansas Health System, Kansas City, Kansas, USA.


This multidisciplinary quality improvement project was designed to enhance telephone communication between patients and their resident physician while concomitantly creating a standardised telephone communication protocol for resident internal medicine continuity clinics. The plan, do, study, act (PDSA) quality improvement framework model was applied for four distinct cycles. Baseline data were collected regarding open telephone encounters. The initial intervention entailed targeted communication to specific individual residents with open telephone encounters more than one SD above the average. The next cycle involved developing a novel communication process map that was distributed to faculty preceptors and clinic anchor nurses. The faculty preceptors then disseminated the new policies and communication algorithm to resident physicians. Finally, new resident and anchor nurses were educated about the standardised processes through scheduled orientation activities. After 19 months of implementation of this project with four PDSA cycles, resident open telephone encounters decreased by 40.7%. Resident telephone communication in continuity clinics can be improved through targeted individualised communication, implementation of a standardised telephone communication protocol, dissemination of communication algorithms to clinic faculty, residents and nurses and ongoing education to all parties through orientation activities to instil a self-sustaining culture change.


communication; healthcare quality improvement; medical education; pdsa; primary care

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